WHAT IS A HERNIATED CERVICAL DISC?
The spine is composed of a series of bones called "vertebrae."  There are seven of these vertebrae in the neck (cervical spine).  The vertebrae surround the spinal cord and protect it from damage.  Nerves branch off the spinal cord travel to the rest of the body, allowing for communication between the brain and the body.

The vertebrae are connected by a disc and two small joints called "facet" joints. The disc, which is made up of strong connective tissues which hold one vertebra to the next, acts as a cushion or shock absorber between the vertebrae. The disc and facet joints allow for movements of the vertebrae and therefore let you bend and rotate your neck and back.

The disc is made of a tough outer layer called the "annulus fibrosus" and a gel-like center called the "nucleus pulposus."  As you get older, the center of the disc may start to lose water content, making the disc less effective as a cushion.  As a disc deteriorates, the outer layer can also tear.  This can allow the disc's center or nucleus to protrude through a crack in the outer layer, into the space occupied by the nerves and spinal cord.  This is called a herniated or ruptured disc.  The herniated disc can then press on the nerves and cause pain, numbness, tingling or weakness in the shoulders or arms.  These radiating arm symptoms are called “radiculopathy”.  Rarely, the herniated disc may put pressure on the spinal cord, causing problems in the legs as well, a syndrome called “myelopathy”.

 

HOW IS IT DIAGNOSED?
The diagnosis of a herniated disc is often made based on a patient’s description of the character and location of pain combined with a thorough neurologic examination to evaluate for arm or hand weakness, loss of sensation or abnormal reflexes.
The doctor's diagnosis can be confirmed by using X-ray imaging, computed tomography (CT) scans or magnetic resonance imaging (MRI).  The X-ray image can show bone spurs and narrowing of the disc space as the spine ages and deteriorates, but cannot show a disc herniation or nerves in the spine.  The CT and MRI scans provide more detailed pictures of all the spinal elements (vertebrae, discs, spinal cord and nerves) and can identify most disc herniations.

Additionally, electrical (nerve conduction) studies may be performed to look for signs or evidence of nerve damage that can result from a disc hernation.

 

WHAT TREATMENTS ARE AVAILABLE?
Many patients will improve with nonsurgical treatment.  Your doctor may prescribe nonsurgical treatments including a short period of rest, a neck collar, anti-inflammatory medications to reduce the swelling, analgesic drugs to control the pain, physical therapy, exercise or epidural steroid injection therapy.  The goals of nonsurgical treatment are to reduce the irritation of the nerve from the herniated disc material, relieve pain and improve the physical condition of the patient.  This can be accomplished in the majority of herniated disc patients with an organized care program that often combines a number of treatment methods. Ask your doctor whether you should continue to work while you are being treated.
After the onset of pain from a herniated cervical disc, a short (one to two days) period of rest may be beneficial.  After this short period of rest, it is important to begin moving again to prevent stiff joints or weak muscles.  Your doctor, with the help of a nurse or physical therapist, may also begin education and training on specific exercises to strengthen your neck.  These exercises may be performed at home or you may visit a physical therapist for a more specific program to meet your needs and abilities.  It is important to perform the exercises as described by the doctor or physical therapist.
Your doctor or physical therapist may also use traction, electric stimulation, hot packs, cold packs and manual ("hands on") therapy to reduce your pain, inflammation and muscle spasm.

 

Medication and pain management
Medications used to control pain are called analgesics.  Most pain can be treated with nonprescription medications such as aspirin, ibuprofen (Motrin, Nuprin, Advil), naproxen (Aleve) or acetaminophen (Tylenol). If you have severe persistent pain, your doctor might prescribe narcotics for a short time.  Sometimes your doctor will prescribe muscle relaxants.  However, you want to take only the medication you need because taking more doesn't help you recover faster, might cause unwanted side effects (such as constipation and drowsiness) and can result in dependency.  All medication should be taken only as directed.  Make sure you tell your doctor about any kind of medication you are taking---even over-the-counter drugs or supplements --- and if he/she prescribes pain medication, let him/her know how it is working for you.  Also, be sure to notify your doctor of any allergic reactions to medication you have ever experienced.
Nonsteroidal anti-inflammatory medications (NSAIDs) are analgesics and are also used to reduce swelling and inflammation that occur as a result of disc herniation. These include aspirin, ibuprofen, naproxen and a variety of prescription drugs.  If your doctor gives you anti-inflammatory medications, you should watch for side effects like stomach upset or bleeding.  Chronic use of prescription or over-the-counter NSAIDs should be monitored by your physician for the development of any potential problems.
Corticosteroid medications, either orally or by injection, are sometimes prescribed for more severe arm and neck pain because of their very powerful anti-inflammatory effect.  Corticosteroids, like NSAIDs, can have side effects.  Risks and benefits of this medication should be discussed with your physician.

 

Cervical Epidural Steroid Injections
Epidural steroid injections may be performed if you have severe arm pain.  These are injections of corticosteroid into the epidural space (the area within the spinal canal around the spinal nerves).  These procedures are performed by the Resurgens Spine Center physiatrists (pronounced fizz-eye-a-trist).  Physiatrists are medical doctors that specialize in the non-surgical treatment of neck and back pain.  The injections are performed in one of our six outpatient surgery centers.  The initial injection may be followed by one or two more injections at a later date.  Although the steroid medicine does not remove or shrink the herniated disc material, it can reduce inflammation of the nerve and the disc.  In some cases, this will provide enough pain relief to avoid the need for surgery.  However, if you have muscle weakness, surgery may be necessary even though the pain has been relieved.

Click the following link to learn more about   Cervical Epidural Steroid Injection

 

WHAT ARE THE SURGICAL TREATMENT OPTIONS?
For patients whose pain does not improve with the previous treatments, surgery may be necessary.  Surgery is indicated for the following conditions:

 

·         Symptoms that have failed to respond to six weeks of treatment
·         Intolerable arm pain
·         Significant or progressive arm or hand weakness caused by the disc herniation

The goal of surgery is to remove the portion of the disc that is pushing on the nerve.  Depending on the location of the herniated disc, the surgeon may be able to remove the disc through an incision either in the front or back of your neck.  The technical decision of whether to perform the operation from the front of the neck (anterior approach) or the back of the neck (posterior approach) is influenced by many factors including the exact location of the disc herniation and the experience and preference of the surgeon.  The majority of disc herniations are treated an anterior approach.   With either approach, the disc material is removed from the nerve, usually with good results.  

 

Anterior Cervical Discectomy and Fusion (ACDF)
This procedure is performed for the majority of cervical disc herniations and is the gold-standard to which all other surgical techniques for cervical disc herniation are compared.  This surgery can treat most all disc herniations and has excellent results in most cases.  The surgery involves making a small incision in the front of the neck, just to the side of the “Adam’s apple”.  Through this incision, retractors are used to hold the soft tissues out of the way while the disc is removed from in between two adjacent bones in the front of the spinal column.  As the disc is removed, the pressure is relieved from the nerve root and spinal cord.  After the disc is removed the disc-space is filled with a bone graft or other device that has bone graft placed inside.  A thin titanium plate may be placed over the disc space, on the front of the spine, and secured to the bones with screws.

Click the following link to learn more about    Anterior Cervical Discectomy and Fusion (ACDF) 

 

Cervical Artificial Disc Replacement
Cervical disc replacement surgery is an alternative to ACDF for certain patients.  The surgery is essentially the same as an ACDF except that instead of placing a bone graft or fusion device into the disc-space, the surgeon places an implant that stabilizes the segment, but allows for continued motion. 

Click the following link to learn more about   Cervical Artificial Disc Replacement

 

Posterior Cervical Foraminotomy and Discectomy

Certain types of disc herniations may be removed without having to take out the entire disc.  This is done through an incision in the back of the neck (posterior approach).  A retractor is used to hold the muscle tissue out of the way, and a small amount of bone over the spinal canal is removed to give the surgeon access to the spinal canal, nerve root, and underlying disc herniation.  The bone removal is called a foraminotomy.  Once this is done, the compressed nerve is slightly retracted, and the underlying disc herniation is removed.  The nerve root is allowed to return to its normal position and the incision is closed. 

Click the following link to learn more about   Posterior Cervical Foraminotomy and Discectomy

 

If you are a candidate for surgery, you should discuss the advantages and potential disadvantages of each of the available procedures with your surgeon.